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What Role Do Pharmacies Play In The Opioid Epidemic?

HOST, KLARA BAUTERS: The U.S. is dealing with an opioid epidemic that’s killing more than 70 thousand people each year. And in an effort to diminish overdose deaths the government has placed heavy restrictions on the prescription of controlled substances.

But public health experts say pharmacies, and national chains in particular, have also contributed to the epidemic. As Giulia Leo reports, critics say that while prescribing a controlled substance gets harder and harder, the process of purchasing it is still not properly regulated.


On December 18, 2009, April Rovero got a call that would forever change her life. It was about her youngest son Joey.


We got a call from his girlfriend letting us know that he had been found on his off campus apartment, unresponsive. Downstream from that, we learned that he had passed away in his bedroom there, and that the cause of death was actually multiple substances in a system that included prescription drugs he had been prescribed by a doctor just nine days before.


Rovero shows me a slideshow. Joey as a baby in red and blue overalls, Joey in his football uniform, Joey posing for his school picture.


He was a great person, a great young person that had all the potential in the world. And unfortunately, it will never be realized.


Joey was just 21 when he died. After his death, Rovero founded the National Coalition Against Prescription Drug Abuse.

His mom blames Joey’s death on the doctor who she says prescribed him a dangerously high-dosage cocktail of Xanax, Soma, and Oxycodone, which are all controlled substances – drugs whose circulation is restricted by the government because they can cause addiction.

The doctor was later convicted of second degree murder and sentenced to prison for the overdose death of three of her patients, including Joey.

But Rovero says the blame is not just on the doctor.


The entire supply chain was really complicit in the end and it was all about money for all of these different entities. 


And Rovero says the pharmacy didn’t run proper checks.


…The pharmacy consistently filled her prescriptions with no questions asked.


The number of people dying from prescription drug overdoses has grown sixfold over the past two decades. 

Since 2017, the U.S. has implemented laws to limit the inappropriate prescription of controlled substances – and opioids in particular. But while prescribers are being required to take all sorts of precautions, pharmacies are not as tightly regulated.

Until April of this year, Marty Roger worked at a CVS here in New York City. He was a technician – not a pharmacist but still one of the gatekeepers, the people on the other side of the counter, physically handing out drugs to clients.

He told me about instances when he handed out controlled substances without asking any questions.


We would get a few people late at night throughout the time who were like pretty clearly high. And like one guy who was like “I'm going to be right back. I'm going to go do coke” while he was like, waiting for the pharmacist to fill his oxy prescription. But in that situation, it's like, yeah, it's New York, and we're living on Columbus Circle and it's 11 p.m. if I tell the pharmacist he's just going to be confused as to why I'm telling him, like, everybody knows. So you just put it through.


Critics say it is moments like this that can lead to the death of people like Joey Rovero. And Roger says he was troubled by what he experienced on the job. It’s why he agreed to use his name in this radio story.

A CVS spokesperson said via email that employees can report workplace concerns - anonymously if they’re worried about retaliation. But Rogers says he didn’t feel confident about that promise.


I, like, kind of kept my mouth shut because I was brand new and like, I was like, okay, well, I got to, like, learn what the culture is here. And then I realized that the culture there is that there is no proper way to do things. It's just get everything out of your face as fast as possible.


Over the past decade, thousands of lawsuits have been filed against CVS and other big pharmacy chains for allegedly mishandling opioids. Last year, the county’s three largest pharmacies agreed to a big national settlement.


CVS and Walgreens paying out 10 billion dollars to settle lawsuits over the opioid crisis.


CVS, Walgreens, and Walmart have tentatively agreed to pay at least 12 billion dollars.


The lawsuits accuse the chain of filling opioid prescriptions that should have been flagged as inappropriate.


According to legal documents from the case, the pharmacies agreed to a list of reforms intended to improve safety and better monitor suspicious orders. The changes were also designed to help pharmacists make more attentive judgements. But some experts say there are still big problems in New York. 

To understand why, we have to go way back before the settlement. 2013. That’s when New York introduced an electronic database where pharmacists and doctors could track controlled substance prescriptions. It’s called the Prescription Monitoring Program, or PMP, and it’s still in place today.

Lewis Nelson acted as consultant for the PMP in the program’s early days. He’s a physician.


Let's pretend like you were prescribing me a substance, for example. And what would the process be of checking out the prescription monitoring program today?


You are supposed to go into the Prescription Monitoring Program and see your patients’ recent and remote prescribing history. 

LEO 10

In other words, it’s another way for doctors to make sure patients aren’t involved in suspicious activities. 


...And you are supposed to make a decision based on that, whether or not they are being overprescribed, whether or not there's some aberrant use potential, so that you won't then prescribe more opioids or any controlled substance for that matter, for that patient.

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By law, prescribers in New York state – meaning doctors – have to check the PMP before writing a prescription for a controlled substance. But Nelson says they don’t always… Why? 


It is a lot of work. I mean, you know, it does take I don't know, you know, a minute or two, but it's a minute or two that just adds up over time, it’s interruptive of a flow.

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But unlike physicians, pharmacists are not required to check the PMP. They’re only invited to. Which means that, in many cases, they don’t. That’s according to Nathaniel Rickles. 


Unfortunately that takes time. 

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Rickles teaches Pharmacy Practice at the University of Connecticut and worked as a Pharmacist for almost three decades, including a few years in New York State.


And if you're in a busy pharmacy where you're trying to make some profit you don't always have the time.


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Rickles says that if a pharmacist suspects someone picking up a substance might be misusing it, then they should check in with the prescriber. But, once again, time is a big problem, especially if you work in an understaffed big pharmacy chain. And even when there is time to check in with the doctor, a pharmacist is likely to receive an answer along the lines of…


“Hey, why are you bothering me?”

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This is the beginning of a problematic chain: a doctor files a prescription for a controlled substance but might not check the database. Next, the prescription goes to the pharmacist, who also might not check the database because the law does not require them to. Sure, they could call the physician, but maybe they’re short on time. So they may fill the prescription anyway. Finally, it’s pharmacy techs like Marty Roger who become the last link of the chain before medication reaches a client.

Roger says he noticed another problem. A CVS policy requires an ID for everyone picking up a controlled   substance. But he says it’s very easy to override the system, which makes the practice useless, 



I asked what the procedure is here several times and eventually just kind of figuring out, okay, it doesn't matter what I do, nobody cares. Nobody wants to tell me what to do. So I’ll stop asking.

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CVS says the policies in place at their pharmacies are comprehensive. That their pharmacy teams are trained in “the appropriate and lawful dispensing of prescribed controlled substances“. And that the company supports the fight against opioid misuse.

Joey Rovero’s mom, April, says that fight needs to include tighter restrictions so that kids like her son have a better chance of avoiding overdose. 

Giulia Leo, Columbia Radio News.


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